Recommendation* People with a diagnosis of OHT, suspected COAG or COAG should be monitored and treated by a trained healthcare professional who has all of the following:
  • a specialist qualification (when not working under the supervision of a consultant ophthalmologist)
  • relevant experience
  • ability to detect a change in clinical status.
Relative values of different outcomesTreatment decisions are dependent upon:
Diagnosis, including being alert to ocular and systemic comorbidities
Severity of COAG or level of conversion risk
Effectiveness, contra-indications, precautions and interactions of existing anti-COAG medications
Tolerance of current anti-COAG medications
Systemic conditions and medications
Trade off between clinical benefits and harmsTreatment by non-medical healthcare professionals or non- ophthalmologists will increase the number of healthcare professionals available from which care may be accessed.
Economic considerationsNone
Quality of evidenceThe clinical evidence was of moderate quality. Studies were not carried out in a systematic and controlled way and there was the potential for selection bias as some patients were volunteers.
Other considerationsThere are not enough ophthalmologists at present to do all the work required so the work needs to be shared. Currently hospital lists are full and this results in delayed appointments.
Evidence is only available for optometrists, with no studies available for other non-medical healthcare professionals or non-ophthalmologist medical staff.

From: 10, Service Provision

Cover of Glaucoma
Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension.
NICE Clinical Guidelines, No. 85.
National Collaborating Centre for Acute Care (UK).
Copyright © 2009, National Collaborating Centre for Acute Care.

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